most interesting ortho cases/complications

P_RN, ADN, RN · Aug 19, 2001

Hi there! As you can see this isn't an exactly "jumping forum."

I've done ortho for mega years and seen mega stuff. All the total joints, PEs (totally frightening), infections, osteomyelitis, tumors, all kind of fractures, decubitus ulcers and prima dona doctors. I even know how to set up most traction.

What kind of things have you run into?

BlueBear · Aug 21, 2001

Hi folks! Sorry i haven't been around in a while but with summer and 3 kids, well I am just totally wiped out!

Anyway, interesting patients? Well today I discharged a 36 y.o. female who came in after a MVA. Pretty routine, right? Well, she has a histry of traumatic sexual abuse as a child and has a HX of multiple personality disorder, PTSD, Dissociative Personality disorder etc. I was asked to be her primary nurse for 5 days in a row in order to continue continuity of care and help her as far as her psych issues were concerned. She did eventually go home, and I feel very good about that. Her musculoskeletal injuries were not terrible, but having to deal with the psych issues made dealing with the physical issues that more difficult. It was interesting, fun, and quite a challenge!

Let's see.... I had a patient once die from a PE- had to sit and watch as she died as she was a DNR. Also have had many patients shipped off to telemetry because their hearts just could not handle surgery but the ortho docs felt that these 80-90 year olds had to have their hips fixed.

OK, I'll stop rambling. Anyone else?

lucieRN. · Aug 22, 2001

Hi again,

Thanks for your fast replies(aka Big Bear, Mod Squad. I guess its true, ortho cases are not always dramatic. Lately, on our floor (its a surgical floor not only ortho pts) I've been getting more GI pts (SBO, pancreatic CA, laryngeal CA, cholelithiasis/ cholecystitis. But I had a very interesting pt last week before she went to surgery- her fourth on her spine. I watched part of her surgery- it lasted for a total of 12 hrs. The surgeons fused 4 vertebrae, (they took bone grafts from the iliac crest, inserted and grafted those pieces where the disks had ruptured) and corrected her kyphosis by removing bone from the rib cage. The pt is in the ICU for one week, then she will be coming to my floor. And yes, those ortho docs are prima donnas, but lets face it, they kind of deserve it. (Who wants to play contruction in someones spine? Chisel anyone? Burr drill?)

I just started, so really not much to report here, sorry! I have seen one PE, but it did resolve (sats went down to 79%).

LucieRN

JillRN · Sep 18, 2001

In response to interesting patients, I work on an Ortho floor in a large teaching hospital. Like any other hospital, we get our share of medical patients as well. One of my favorites is a young man who is profoundly schizophrenic. It is a very sad situation. His x-rays are in medical books as he feels the need to swallow objects: lighters, small toys, razors, knives, forks, spoons, and, most recently, hangers. yes, metal clothes hangers which he can bend and get down. His esophagus obviously is extremely scarred. He makes you stop and thank God for what you have but it also makes one very sad when learning of his upbringing and the abuse he suffered. Why does he come to the ortho floor? Continuity. He trusts us and we limit set.

And of course, we have our fair share of other bizarre ortho cases which I believe are probably universal....the mva's with the dui's. My favorite was a 45 year old male brought in 4 a.m. on a Sunday morning with an ETOH level off the charts. He informed us he was on his way back from mass and that was the communion wine and he was not intoxicated. :)

mjamesRN · Feb 25, 2002

I agree with Blue Bear about these 90 year olds getting new hips. Point, please? They couldn't ambulate to begin with. Many come back with infections because of poor care at LTC facilities, and secondary decubs -- what a mess! Removal of hardware, I & Ds, a week or two of dementia from morphine. Our ortho unit is often transformed into Geri-psyche -- restraint orders for everyone! yanking out their lines and Foleys and scrambling over siderails. That's when a hard night's work deserves a week off.

alyca · May 12, 2004

It's been a long time since this thread was used, but I have tons of iteresting ortho cases!

A 23 yo male who was into bodybuilding and took a few steroids along with creatine, ended up overdosing on creatine and developing severe rhabdo, lost most of his calves, quads, triceps, some abd muscles, etc. Amazing thing is that he actually can walk now, in a stilted sort of way.

Also, a woman who was in septic shock a few years ago and had bilateral BKA's done, lost both thumbs and index fingers, has had dozens of flaps and skin grafts done to preserve her arms and remaining legs, and she is ambulatory as well, with prosthetics. SHe coded x4 a day after her initial admission for sepsis, had 90+ minutes of CPR done, and is totally fine-no neuro deficits, etc. Amazing.

We get tons of replants of fingers, thumbs, once even a guy who managed to chop off his thumb in one piece, and his 4 fingers all together with part of his hand. We managed to reattach all of it, and sent him home with two full hands.

I have a lady right now with some huge anxiety issues-she was artificially inseminated 2 days before having a high speed MVA, lost any viable embryos, shattered her pelvis and has an ex-fix there, also shattered her humerus and has a nasty pilon fx requiring another spanning ex fix. Her husband also shattered his pelvis, but was released home already. THis lady has 2 DVT's, and is non weightbearing on three extremities, but is doing pretty good. She is at the point where she tells me she has a lot of scars now, but is proud of that, because she will be walking away one of these days. So nice to see people getting better! That is why I love ortho--people come in broken, but leave whole. They may be leaving with out a foot or unable to walk or with some sort of severe limitations compared to where they were pre-accident, but they are going home. They are getting better.

Anyway......